Clement P B, Young R H, Keh P, Ostör A G, Scully R E
Department of Pathology, Vancouver Hospital and Health Sciences Centre, Canada.
Am J Surg Pathol. 1995 Oct;19(10):1158-71. doi: 10.1097/00000478-199510000-00006.
Eight mesonephric adenocarcinomas of the uterine cervix, four of which had a malignant spindle-cell component, occurred in women aged 34 to 71 (median 43, mean 54.5) years, bringing to 14 the number of cervical mesonephric carcinomas in the literature. The tumors with a malignant spindle-cell component ("malignant mesonephric mixed tumors") are, with one possible exception, the first reported examples at this site. The patients, almost all of whom presented with vaginal bleeding, underwent hysterectomy; five also had a pelvic lymph node dissection. The tumors were all stage IB, although microscopic lymph node metastases were found in two cases. Gross examination revealed an invasive cervical mass in each case. On microscopic examination, seven tumors were adjacent to mesonephric hyperplasia, which in five cases was florid and focally atypical; in the remaining case, occasional non-neoplastic mesonephric tubules were found only within the tumor. The adenocarcinomas typically exhibited a variety of patterns, including a ductal pattern resembling endometrioid adenocarcinoma, a small tubular pattern, a retiform pattern, a solid pattern, and a sex-cord-like pattern. These disparate patterns frequently caused diagnostic difficulty. The spindle-cell component generally resembled endometrial stromal sarcoma or a nonspecific spindle-cell sarcoma; one tumor also contained multiple foci of osteosarcoma and another, a single chondroid focus. Immunohistochemical staining for a variety of antigens failed to reveal a distinctive profile, although all the carcinomas were immunoreactive for vimentin. Follow-up in six cases revealed three patients to be alive without evidence of recurrence at postoperative intervals of 2 to 3 years. Recurrent tumor developed in a fourth patient 1 year after hysterectomy; she was treated with chemotherapy and was alive and free of disease at 2 years. Another patient had intra-abdominal recurrences (including liver metastases) at 9 and 11 years and was alive with tumor at 13 years. Death at 8.5 months in a final patient was probably due to an independent stage IIc ovarian clear-cell carcinoma. These and prior observations in the literature suggest that malignant mesonephric tumors of the cervix may be more indolent than their müllerian counterparts, from which they should be distinguished. Mesonephric carcinomas in this site should also be distinguished from florid mesonephric hyperplasia, with which they are usually associated.
8例子宫颈中肾腺癌，其中4例含有恶性梭形细胞成分，患者年龄34至71岁（中位年龄43岁，平均年龄54.5岁），使文献报道的子宫颈中肾腺癌病例数增至14例。含有恶性梭形细胞成分的肿瘤（“恶性中肾混合瘤”），除1例可能例外，均为此部位首次报道的病例。患者几乎均因阴道出血就诊，均接受了子宫切除术；5例还进行了盆腔淋巴结清扫术。肿瘤均为IB期，不过2例发现有微小淋巴结转移。大体检查显示每例均有宫颈浸润性肿块。显微镜检查发现，7例肿瘤与中肾增生相邻，其中5例增生明显且局灶性不典型；其余1例仅在肿瘤内发现偶尔的非肿瘤性中肾小管。腺癌通常呈现多种形态，包括类似子宫内膜样腺癌的导管样形态、小腺管样形态、网状形态、实体形态和性索样形态。这些不同的形态常导致诊断困难。梭形细胞成分通常类似子宫内膜间质肉瘤或非特异性梭形细胞肉瘤；1例肿瘤还含有多个骨肉瘤灶，另1例含有单个软骨样灶。尽管所有癌均对波形蛋白呈免疫反应，但对多种抗原进行免疫组化染色未显示出独特的特征。6例患者的随访结果显示，3例患者术后2至3年存活且无复发迹象。第4例患者子宫切除术后1年出现复发性肿瘤；她接受了化疗，2年后存活且无疾病。另1例患者分别在9年和11年出现腹腔内复发（包括肝转移），13年时带瘤存活。最后1例患者在8.5个月时死亡，可能是由于独立的IIc期卵巢透明细胞癌。这些以及文献中的既往观察结果表明，宫颈恶性中肾肿瘤可能比其苗勒管来源的对应肿瘤生长更缓慢，应与之相鉴别。此部位的中肾腺癌还应与通常与之相关的明显中肾增生相鉴别。
